Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

C DIFFICILE TOX A & B

Facility

$390.00

Service Code	HCPCS 87324
Hospital Charge Code	3000944
Hospital Revenue Code	300
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

C DIFFICILE TOX A & B

Facility

$390.00

Service Code	HCPCS 87324
Hospital Charge Code	3000944
Hospital Revenue Code	300
Min. Negotiated Rate	$9.58
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$32.59
Rate for Payer: Aetna Medicare Advantage	$38.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.24
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$11.98
Rate for Payer: Clover Medicare Advantage	$11.38
Rate for Payer: EmblemHealth Commercial	$35.94
Rate for Payer: Humana Medicare Advantage	$12.34
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$11.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$9.58
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.98
Rate for Payer: Wellcare Medicare Advantage	$11.98
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

C DIFFICILE TOXIN B

Facility

$164.85

Service Code	HCPCS 87230
Hospital Charge Code	3000942
Hospital Revenue Code	300
Min. Negotiated Rate	$4.37
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$53.69
Rate for Payer: Aetna Medicare Advantage	$63.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$71.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$71.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$19.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$52.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$71.26
Rate for Payer: Cigna Commercial	$82.42
Rate for Payer: Cigna Medicare Advantage	$19.74
Rate for Payer: Clover Medicare Advantage	$18.75
Rate for Payer: EmblemHealth Commercial	$59.22
Rate for Payer: Humana Medicare Advantage	$20.33
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$19.74
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$49.45
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$24.73
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$15.79
Rate for Payer: UnitedHealthcare Medicare Advantage	$19.74
Rate for Payer: Wellcare Medicare Advantage	$19.74
Rate for Payer: Wellpoint Medicaid Managed Care	$4.37

C DIFFICILE TOXIN B

Facility

$164.85

Service Code	HCPCS 87230
Hospital Charge Code	3000942
Hospital Revenue Code	300
Min. Negotiated Rate	$24.73
Max. Negotiated Rate	$24.73
Rate for Payer: Qualcare PPO/HMO/WC	$24.73

CD STRYKER ENDOSCOPY

Facility

$13.80

Hospital Charge Code	270657631
Hospital Revenue Code	270
Min. Negotiated Rate	$2.07
Max. Negotiated Rate	$2.07
Rate for Payer: Qualcare PPO/HMO/WC	$2.07

CD STRYKER ENDOSCOPY

Facility

$13.80

Hospital Charge Code	270657631
Hospital Revenue Code	270
Min. Negotiated Rate	$0.33
Max. Negotiated Rate	$6.90
Rate for Payer: Aetna Commercial	$5.24
Rate for Payer: Aetna Medicare Advantage	$4.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.52
Rate for Payer: Cigna Commercial	$6.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.14
Rate for Payer: Oxford Commercial	$2.76
Rate for Payer: Qualcare PPO/HMO/WC	$2.07
Rate for Payer: UnitedHealthcare Commercial	$2.76
Rate for Payer: UnitedHealthcare Community & State	$0.33
Rate for Payer: Wellpoint Medicaid Managed Care	$0.37

CDX2 IHC

Facility

$1,082.30

Service Code	HCPCS 88342
Hospital Charge Code	4016883420
Hospital Revenue Code	310
Min. Negotiated Rate	$28.68
Max. Negotiated Rate	$730.60
Rate for Payer: Aetna Commercial	$550.53
Rate for Payer: Aetna Medicare Advantage	$655.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$730.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$730.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$202.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$730.60
Rate for Payer: Cigna Commercial	$405.73
Rate for Payer: Cigna Medicare Advantage	$202.40
Rate for Payer: Clover Medicare Advantage	$192.28
Rate for Payer: EmblemHealth Commercial	$607.20
Rate for Payer: Humana Medicare Advantage	$208.47
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$202.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$324.69
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$162.34
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Community & State	$86.39
Rate for Payer: UnitedHealthcare Medicare Advantage	$202.40
Rate for Payer: Wellcare Medicare Advantage	$202.40
Rate for Payer: Wellpoint Medicaid Managed Care	$28.68

CDX2 IHC

Facility

$1,082.30

Service Code	HCPCS 88342
Hospital Charge Code	4016883420
Hospital Revenue Code	310
Min. Negotiated Rate	$162.34
Max. Negotiated Rate	$162.34
Rate for Payer: Qualcare PPO/HMO/WC	$162.34

CEA***

Facility

$68.00

Hospital Charge Code	3010667
Hospital Revenue Code	309
Min. Negotiated Rate	$1.64
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$25.84
Rate for Payer: Aetna Medicare Advantage	$20.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.34
Rate for Payer: Cigna Commercial	$34.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.40
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$10.20
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$1.64
Rate for Payer: Wellpoint Medicaid Managed Care	$1.80

CEA***

Facility

$68.00

Hospital Charge Code	3010667
Hospital Revenue Code	309
Min. Negotiated Rate	$10.20
Max. Negotiated Rate	$10.20
Rate for Payer: Qualcare PPO/HMO/WC	$10.20

CEA, CARCINOEMBRYONIC AG

Facility

$667.59

Service Code	HCPCS 82378
Hospital Charge Code	3000668
Hospital Revenue Code	301
Min. Negotiated Rate	$15.17
Max. Negotiated Rate	$333.80
Rate for Payer: Aetna Commercial	$51.57
Rate for Payer: Aetna Medicare Advantage	$61.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$68.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$68.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$43.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$68.44
Rate for Payer: Cigna Commercial	$333.80
Rate for Payer: Cigna Medicare Advantage	$18.96
Rate for Payer: Clover Medicare Advantage	$18.01
Rate for Payer: EmblemHealth Commercial	$56.88
Rate for Payer: Humana Medicare Advantage	$19.53
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$18.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$200.28
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.14
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$15.17
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.96
Rate for Payer: Wellcare Medicare Advantage	$18.96
Rate for Payer: Wellpoint Medicaid Managed Care	$17.69

CEA, CARCINOEMBRYONIC AG

Facility

$667.59

Service Code	HCPCS 82378
Hospital Charge Code	3000668
Hospital Revenue Code	301
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

CEA PLEURAL FLUID

Facility

$130.40

Service Code	HCPCS 82378
Hospital Charge Code	39900055
Hospital Revenue Code	301
Min. Negotiated Rate	$3.46
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$51.57
Rate for Payer: Aetna Medicare Advantage	$61.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$68.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$68.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$43.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$68.44
Rate for Payer: Cigna Commercial	$65.20
Rate for Payer: Cigna Medicare Advantage	$18.96
Rate for Payer: Clover Medicare Advantage	$18.01
Rate for Payer: EmblemHealth Commercial	$56.88
Rate for Payer: Humana Medicare Advantage	$19.53
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$18.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$39.12
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$19.56
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$15.17
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.96
Rate for Payer: Wellcare Medicare Advantage	$18.96
Rate for Payer: Wellpoint Medicaid Managed Care	$3.46

CEA PLEURAL FLUID

Facility

$130.40

Service Code	HCPCS 82378
Hospital Charge Code	39900055
Hospital Revenue Code	301
Min. Negotiated Rate	$19.56
Max. Negotiated Rate	$19.56
Rate for Payer: Qualcare PPO/HMO/WC	$19.56

CECLOR/125MG/5ML

Facility

$71.00

Hospital Charge Code	60632649
Hospital Revenue Code	250
Min. Negotiated Rate	$10.65
Max. Negotiated Rate	$10.65
Rate for Payer: Qualcare PPO/HMO/WC	$10.65

CECLOR/125MG/5ML

Facility

$71.00

Hospital Charge Code	60632649
Hospital Revenue Code	250
Min. Negotiated Rate	$1.71
Max. Negotiated Rate	$35.50
Rate for Payer: Aetna Commercial	$26.98
Rate for Payer: Aetna Medicare Advantage	$21.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.11
Rate for Payer: Cigna Commercial	$35.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.30
Rate for Payer: Oxford Commercial	$14.20
Rate for Payer: Qualcare PPO/HMO/WC	$10.65
Rate for Payer: UnitedHealthcare Commercial	$14.20
Rate for Payer: UnitedHealthcare Community & State	$1.71
Rate for Payer: Wellpoint Medicaid Managed Care	$1.88

CECLOR/125MG/5ML

Facility

$135.00

Hospital Charge Code	60632650
Hospital Revenue Code	250
Min. Negotiated Rate	$3.25
Max. Negotiated Rate	$67.50
Rate for Payer: Aetna Commercial	$51.30
Rate for Payer: Aetna Medicare Advantage	$40.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$34.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$34.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$34.42
Rate for Payer: Cigna Commercial	$67.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$40.50
Rate for Payer: Oxford Commercial	$27.00
Rate for Payer: Qualcare PPO/HMO/WC	$20.25
Rate for Payer: UnitedHealthcare Commercial	$27.00
Rate for Payer: UnitedHealthcare Community & State	$3.25
Rate for Payer: Wellpoint Medicaid Managed Care	$3.58

CECLOR/125MG/5ML

Facility

$135.00

Hospital Charge Code	60632650
Hospital Revenue Code	250
Min. Negotiated Rate	$20.25
Max. Negotiated Rate	$20.25
Rate for Payer: Qualcare PPO/HMO/WC	$20.25

CECLOR/250MG/5ML

Facility

$244.00

Hospital Charge Code	60632647
Hospital Revenue Code	250
Min. Negotiated Rate	$5.88
Max. Negotiated Rate	$122.00
Rate for Payer: Aetna Commercial	$92.72
Rate for Payer: Aetna Medicare Advantage	$73.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$62.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$62.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$62.22
Rate for Payer: Cigna Commercial	$122.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$73.20
Rate for Payer: Oxford Commercial	$48.80
Rate for Payer: Qualcare PPO/HMO/WC	$36.60
Rate for Payer: UnitedHealthcare Commercial	$48.80
Rate for Payer: UnitedHealthcare Community & State	$5.88
Rate for Payer: Wellpoint Medicaid Managed Care	$6.47

CECLOR/250MG/5ML

Facility

$127.00

Hospital Charge Code	60632648
Hospital Revenue Code	250
Min. Negotiated Rate	$19.05
Max. Negotiated Rate	$19.05
Rate for Payer: Qualcare PPO/HMO/WC	$19.05

CECLOR/250MG/5ML

Facility

$244.00

Hospital Charge Code	60632647
Hospital Revenue Code	250
Min. Negotiated Rate	$36.60
Max. Negotiated Rate	$36.60
Rate for Payer: Qualcare PPO/HMO/WC	$36.60

CECLOR/250MG/5ML

Facility

$127.00

Hospital Charge Code	60632648
Hospital Revenue Code	250
Min. Negotiated Rate	$3.06
Max. Negotiated Rate	$63.50
Rate for Payer: Aetna Commercial	$48.26
Rate for Payer: Aetna Medicare Advantage	$38.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32.38
Rate for Payer: Cigna Commercial	$63.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.10
Rate for Payer: Oxford Commercial	$25.40
Rate for Payer: Qualcare PPO/HMO/WC	$19.05
Rate for Payer: UnitedHealthcare Commercial	$25.40
Rate for Payer: UnitedHealthcare Community & State	$3.06
Rate for Payer: Wellpoint Medicaid Managed Care	$3.37

CECLOR/250MG/CAP

Facility

$8.00

Hospital Charge Code	60632643
Hospital Revenue Code	250
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$4.00
Rate for Payer: Aetna Commercial	$3.04
Rate for Payer: Aetna Medicare Advantage	$2.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.04
Rate for Payer: Cigna Commercial	$4.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.40
Rate for Payer: Oxford Commercial	$1.60
Rate for Payer: Qualcare PPO/HMO/WC	$1.20
Rate for Payer: UnitedHealthcare Commercial	$1.60
Rate for Payer: UnitedHealthcare Community & State	$0.19
Rate for Payer: Wellpoint Medicaid Managed Care	$0.21

CECLOR/250MG/CAP

Facility

$8.00

Hospital Charge Code	60632643
Hospital Revenue Code	250
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$1.20
Rate for Payer: Qualcare PPO/HMO/WC	$1.20

CECLOR/250MG/CAP

Facility

$13.00

Hospital Charge Code	60632644
Hospital Revenue Code	250
Min. Negotiated Rate	$0.31
Max. Negotiated Rate	$6.50
Rate for Payer: Aetna Commercial	$4.94
Rate for Payer: Aetna Medicare Advantage	$3.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.31
Rate for Payer: Cigna Commercial	$6.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.90
Rate for Payer: Oxford Commercial	$2.60
Rate for Payer: Qualcare PPO/HMO/WC	$1.95
Rate for Payer: UnitedHealthcare Commercial	$2.60
Rate for Payer: UnitedHealthcare Community & State	$0.31
Rate for Payer: Wellpoint Medicaid Managed Care	$0.34

Know your out-of-pocket cost for care.

All Charges